Not rated by CMS — ratings are suppressed for new or low-volume facilities.
The next survey window likely opens around November 2026
Estimate from public CMS data, current as of June 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Twilight Acres during CMS and state inspections, most recent first.
A resident with severe cognitive impairment, hip fracture, and malnutrition was identified as at risk for pressure sores, but when the Braden score declined from low to moderate risk, the facility did not document additional targeted interventions to prevent pressure ulcers. The care plan contained only general skin care measures, and the clinical record lacked evidence of timely, risk-based prevention despite the increased risk level. The resident subsequently developed a left heel pressure area that progressed to an unstageable ulcer with black eschar and increasing size. The DON later stated there was no established procedure for pressure ulcer prevention and treatment during this period, contrary to NPIAP guidance on structured risk assessment and pressure offloading, including for the heels.
The facility failed to promptly assess and isolate two residents with respiratory symptoms. One resident with severe cognitive impairment and COPD was not isolated until hours after symptoms were noted. Another resident with a history of COVID reported symptoms but was not assessed further or isolated, and vital signs were not recorded for several days. Facility policy required immediate isolation for unexplained respiratory symptoms, which was not followed.
Failure to Escalate Pressure Ulcer Prevention After Increased Risk
Penalty
Summary
The deficiency involves the facility’s failure to provide pressure ulcer prevention and care consistent with professional standards for one resident. The resident had severe cognitive impairment, required staff assistance for mobility and transfers, and had diagnoses including hip fracture and malnutrition. An MDS assessment documented that the resident was at risk for pressure sores but had none at that time, and the care plan identified fragile skin and the need for assistance with activities of daily living, with general interventions such as encouraging nutrition and hydration, keeping skin clean and dry, using lotion on dry skin, and monitoring/documenting skin injuries. A Braden Scale completed later showed the resident’s score had declined from 19 (low risk) to 14 (moderate risk), but the clinical record did not show that the facility identified or implemented additional interventions to address the increased pressure ulcer risk. Subsequently, progress notes documented the development of a new pressure area on the resident’s left heel, initially described as a 2 by 2 cm pressure area with black edges and a white center. Later documentation by the ARNP identified the left heel as having an unstageable pressure area with black eschar, and subsequent measurements showed the wound increasing in size to 3 by 3 cm and then 3.2 by 3 cm. Throughout this period, the record shows that the facility relied on existing care plan elements and did not document timely, risk-based preventive interventions in response to the declining Braden score. The DON reported not knowing when interventions to prevent pressure ulcers were started and stated that they did not really have a procedure to prevent or treat pressure ulcers until recently. The NPIAP guidance cited in the report emphasizes structured risk assessment and development of a plan of care based on identified risk areas, including repositioning and ensuring heels are free from pressure, which contrasts with the lack of documented, timely preventive measures in this case.
Failure to Implement Timely Isolation for Respiratory Symptoms
Penalty
Summary
The facility failed to assess and provide timely interventions for two residents displaying respiratory symptoms. Resident #1, with severe cognitive impairment and diagnoses including COPD and heart failure, exhibited congestion and coughing. Despite these symptoms, isolation precautions were not initiated until the next shift, several hours after the symptoms were first noted. Staff interviews confirmed that isolation should have been implemented immediately upon recognizing the symptoms. Resident #16, with moderate cognitive impairment and a history of COVID, reported coughing, a hoarse voice, and a sore throat. Although a COVID test was negative and cough medicine was administered, the facility did not document further assessments or initiate isolation precautions. Additionally, vital signs were not recorded from the onset of symptoms until several days later. The facility's policy required immediate isolation for residents with unexplained respiratory symptoms, but this was not followed in these cases.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Wall Lake
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Blackhawk Life Care Center | 3 mi | — | 3 | 1 |
| Odebolt Specialty Care | 7.9 mi | — | 3 | 0 |
| Park View Rehabilitation Center | 11.8 mi | — | 9 | 0 |
| Accura Healthcare Of Carroll | 17.6 mi | — | 18 | 0 |
| Accura Healthcare Of Lake City, Llc | 17.6 mi | — | 8 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release August 2026) and official state health department websites.